新鲜出炉 | 2023AABB红细胞输注指南

10月12日，知名期刊JAMA在线发表了special communication，有关于红细胞输血AABB最新指南，临床输血公众号第一时间和各位同行分享。

在本指南发布之前，已有不少指南文件，用于指导临床红细胞输血。由于输血潜在的风险，血液资源的紧张，以及更多临床研究提示，输血阈值可能与患者预后相关，这些丰富的临床研究资料，有必要进行进一步提炼，形成指导文件。

本指南主要推荐：

Recommendation 1: for hospitalized adult patients who are hemodynamically stable, the international panel recommends a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (strong recommendation, moderate certainty evidence). In accordance with the restrictive strategy threshold used in most trials, clinicians may choose a threshold of 7.5 g/dL for patients undergoing cardiac surgery and 8 g/dL for those undergoing orthopedic surgery or those with preexisting cardiovascular disease. 

建议1：对于血液动力学稳定的住院成年患者，国际专家组建议在血红蛋白浓度低于7 g/dL时考虑输血的限制性输血策略（强烈建议，中等确定性证据）。根据大多数试验中使用的限制性策略阈值，临床医生可以为接受心脏手术的患者选择7.5 g/dL的阈值，为接受骨科手术或已有心血管疾病的患者选择8 g/dL。

Recommendation 2: for hospitalized adult patients with hematologic and oncologic disorders, the panel suggests a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (conditional recommendations, low certainty evidence). 

建议2：对于患有血液学和肿瘤学疾病的住院成年患者，专家组建议在血红蛋白浓度低于7 g/dL时考虑输血的限制性输血策略（有条件的建议，低确定性的证据）。

Recommendation 3: for critically ill children and those at risk of critical illness who are hemodynamically stable and without a hemoglobinopathy, cyanotic cardiac condition, or severe hypoxemia, the international panel recommends a restrictive transfusion strategy considering transfusion when the hemoglobin concentration is less than 7 g/dL (strong recommendation, moderate certainty evidence). 

建议3：对于危重儿童和那些血液动力学稳定且没有血红蛋白病、发绀性心脏病或严重低氧血症的有危重症风险的儿童，国际专家组建议在血红蛋白浓度低于7 g/dL时考虑输血的限制性输血策略（强烈建议，中等确定性证据）。

Recommendation 4: for hemodynamically stable children with congenital heart disease, the international panel suggests a transfusion threshold that is based on the cardiac abnormality and stage of surgical repair: 7 g/dL (biventricular repair), 9 g/dL (single-ventricle palliation), or 7 to 9 g/dL (uncorrected congenital heart disease) (conditional recommendation, low certainty evidence).

建议4：对于血液动力学稳定的先天性心脏病儿童，国际专家组根据心脏异常和手术修复阶段提出了一个输血阈值：7 g/dL（双心室修复）、9 g/d L（单心室姑息）或7至9 g/d（未纠正的先天性心脏病）（有条件的建议，低确定性的证据）

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